Headache Management

Headaches are NOT normal and should be diagnosed, prevented and treated. There are a myriad of headache disorders. Dr. Issa’s goal at the Bellevue Headache clinic is to accurately diagnose what kind of headache you have and then proceed with effective preventive and therapeutic approaches.

Dr Issa is a board certified neurologist and fellowship trained headache specialist providing individualized headache solutions.

She focuses on a comprehensive approach that combines treatment and prevention to put you back in control of your headaches.

Ranging from natural minerals and vitamins to pharmacological medications or injections (Botox, nerve blocks) Dr. Issa tailors her approach to the individual and their lifestyle.

Some of the Types of Headache Disorders Treated at Bellevue Headache Clinic:

Migraines

About 38 million Americans have migraines and migraines are most common from the teen-age years through the 40s, but can occur at any age.

During a migraine, there are abnormal neurochemical changes which leads to one sided  throbbing pain, nausea, vomiting, light and sound sensitivity. Attacks can last from 4-72 hours or longer in which case a condition called status migrainosis occurs. They can be debilitating and chronic (15 or more days of headaches per month).

At the Bellevue Headache Clinic, Dr. Issa’s approach is holistic. Her goal is to identify any modifiable triggers for migraine such as menstruation, medication overuse, sleep disturbances, dietary sensitivities and mood disorders. Once identified, these triggers can be minimized and treated with appropriate interventions. Alongside identifying triggers, medications and non-medication approaches can be initiated with a clear and expected benefit target.

Menstrually-related Migraines 

Menstrually-related migraines occur with changes in hormones which trigger a migraine. These migraines can be severe, prolonged and more treatment resistant. These migraines require a strategic approach prior to their onset to lower their intensity. Dr. Issa educates her patients about this and implements strategies to prevent and successfully treat menstrual headaches.

Pregnancy and Lactation  

During pregnancy and while breast–feeding, many women prefer not to take medications which may cross the placenta or pass through breast milk to their infant. At the Bellevue Headache Clinic, Dr. Issa offers solutions and strategies to manage headaches within the mother’s comfort zone. Nerve blocks may be utilized to break a headache cycle and lower the burden of headaches while topical nasal sprays may be used to stop a migraine attack.

Cluster Headache

This headache is more prevalent in men. It is characterized as severe unilateral headache with eye pain accompanied by symptoms such as eye redness, eye tearing, nasal congestion, pupil changes, facial flushing, and restlessness.

Dr. Issa’s approach to treat cluster headaches is to accurately diagnose them and then prescribe fast acting injections and oxygen therapy to stop the headache in minutes. Preventive medications are used and titrated up to therapeutic benefit. Nerve blocks with steroids are used for transitional relief while preventive medication builds up.

Devices such as gammaCore and Spring TMS may be used to prevent cluster headaches.

Hemicrania Continua

This is a rare but treatable primary headache disorder which shares features with both migraine and cluster Headaches. Clinicians often misdiagnose this headache as either migraine or cluster headaches, leading to treatments that are not effective. Hemicrania Continua is a one-sided continuous baseline headache with exacerbations presenting with eye tearing, nasal congestion, facial flushing, pupillary changes and migrainous features such as nausea, vomiting, light and sound sensitivity. Knowing that this disorder is responsive to a specific anti-inflammatory medication, indomethacin, Dr. Issa can initiate an indomethacin trial to effectively diagnose and manage the patients with Hemicrania Continua.

New Daily Persistent  Headache (NDPH)

This is a rare headache disorder which can begin all of a sudden and persists as a daily headache with  baseline pain which can increase in intensity and may look and feel like  migraine. It is common in adolescents. It requires an extensive diagnostic work up and has limited response to medications. Dr. Issa has extensive experience in managing patients with NDPH, utilizing creative medication and non–medication approaches to help patients lead a productive quality of life

Cervicogenic Headaches

These secondary headaches are common after head and neck trauma such as a whiplash injury or a motor vehicle accident. The source of these headaches which can mimic migraine lies in the neck and can be identified with diagnostic nerve blocks in the neck. Dr. Issa can manage these headaches by working with pain specialists and dedicated physical therapists to diagnose, manage and treat these headaches and their source.

Please see all the other conditions treated and managed at the Bellevue Headache Clinic.